• Skip to primary navigation
  • Skip to main content

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • Leadership
    • SAGES Mission Statement
    • Advocacy
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • SAGES Store
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
    • “Unofficial” Logo Products
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2026 Scientific Session Call For Abstracts
      • 2026 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
    • Future Meetings
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Join the SAGES Patient Partner Network (PPN)
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • Sustainability in Surgical Practice
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • Wellness Resources – You Are Not Alone
    • OpiVoid.org
    • SAGES Video Subscription
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Free Webinars For Residents
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Fluorescence-Guided Surgery Course for Fellows
    • Fellows Career Development Course
    • Robotics Fellows Course
    • MIS Fellows Course
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES Top 21 MIS Procedures
    • SAGES Pearls
    • SAGES Flexible Endoscopy 101
    • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy
    • SAGES Fellowship Recognition Opportunities
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • OWLS / FLS
  • Log In

Results of the Ovesco-Over-Overstitch Technique for Managing Bariatric Surgical Complications

Vamsi V Alli1, Andrew T Strong, MD2, Matthew T Allemang, MD2, Matthew Kroh, MD2, Eric M Pauli, MD1. 1Penn State – Milton S. Hershey Medical Center, 2Cleveland Clinic Foundation

Introduction: Endoscopic management of bariatric surgical complications is commonplace, including the management of leaks and fistulae.  Large or complex full-thickness gastrointestinal (GI) tract defects often require multisession or multimodal therapy for closure. The challenges of this environment limit the utility of any single method for endoscopic closure. This abstract reports the results of bariatric surgical complications managed utilizing a novel technique combining endoscopic suturing and clipping.

Methods: A multicenter retrospective study of patients with full thickness GI tract defects following bariatric surgery. The study sites were two tertiary care academic medical centers. Patients were identified who underwent placement of an Ovesco clip (Tubingen, Germany) on top of a GI tract defect closure using the Overstitch device (Apollo Endosurgery, Austin). This Ovesco-Over-Overstitch (OOO) method was utilized in combination with standard endoscopic adjunct maneuvers such as mucosal ablation.  Procedures were performed by two experienced surgeon-endoscopists.

Results: Ten patients were identified (8 female, mean age of 52 years, mean body mass index of 41 kg/m2); 8 symptomatic gastro-gastric fistula (mean fistula size of 1.6 cm) following gastric bypass, 1 sleeve gastrectomy leak, 1 gastro-plural fistula.  Eight patients underwent OOO in a single session (mean procedure time 99 min). There were two recoverable operative complications (1 suture pull-through, 1 device entanglement) but no post-procedure morbidity.  During follow-up (mean 333 days), there were 8 failed closures (80%), with a mean time to failure of 217 days.  Four failures were ultimately managed surgically, 3 endoscopically, and 1 remained asymptomatic (excluded from consideration for reintervention). 

Discussion: The OOO method led to an overall success rate of 40% for defect closure, with primary efficacy of 20% and an additional 20% rate of salvage with endoscopic therapy.  Sixty percent of patients in this series therefore avoided a complex surgical revision.  Downsizing a large defect via Overstitch and further securing the closure using an Ovesco clip is a viable technique for managing large full-thickness GI tract defects otherwise not be amenable to endoscopic closure.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 88457

Program Number: P375

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

109

Share this:

  • Click to share on X (Opens in new window) X
  • Click to share on X (Opens in new window) X
  • Click to share on Facebook (Opens in new window) Facebook
  • Click to share on LinkedIn (Opens in new window) LinkedIn
  • Click to share on Pinterest (Opens in new window) Pinterest
  • Click to share on WhatsApp (Opens in new window) WhatsApp
  • Click to share on Reddit (Opens in new window) Reddit
  • Click to share on Pocket (Opens in new window) Pocket
  • Click to share on Mastodon (Opens in new window) Mastodon

Related



  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2025 Society of American Gastrointestinal and Endoscopic Surgeons